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Thank you for taking the time to complete our online employment application. Please update your contact information, and attach your resume below. This application will take approximately 15 minutes to complete.

*Denotes a Required Field

Personal Information

First Name: *

Middle Name:

Last Name: *

Nickname/Preferred name:

Address:

City:

State:

Zip Code:

Home Phone: *

Cell Phone:

Email:

Cover Letter:(Optional)

Resume:(Copy and Paste)

Availability

Are you at least 18 years of age and do you have
the legal right to work in the United States?

Yes

No

Are you willing to work temporary?

Yes

No

Are you looking for a full-time career position?

Yes

No

Are you looking for contract positions?

Yes

No

When are you available to start?

What weekday hours are you available?

What weekend hours are you available?

How many hours are you willing to work in a week?

Are you willing to work overtime?

Yes

No

What is the minimum pay you desire?

Hourly rate or annual salary

How much notice will you need if a position is offered to you?

How many miles are you willing to travel to a position?

Education

Enter most recent - Do not enter start and end date if the most recent is high school

Name of School

Type of school

Street Address

City

State

Zip Code

Start Date (Month / Year)

(Enter a four digit year)

End Date (Month / Year)

(Enter a four digit year)

Degree

Major Study Area

Other Studies

Recent Employment

List most recent first

Company Name

Street Address

City

State

Zip Code

Supervisor Name

Job Title

Job Duties

Start Date (Month / Year)

(Enter a four digit year)

End Date (Month / Year)

(Enter a four digit year)

Start Wage

Hourly rate or annual salary

End Wage

Hourly rate or annual salary

May we contact this employer for a reference check?

Yes

No

Company Name

Street Address

City

State

Zip Code

Supervisor Name

Job Title

Job Duties

Start Date (Month / Year)

(Enter a four digit year)

End Date (Month / Year)

(Enter a four digit year)

Start Wage

Hourly rate or annual salary

End Wage

Hourly rate or annual salary

May we contact this employer for a reference check?

Yes

No

Company Name

Street Address

City

State

Zip Code

Supervisor Name

Job Title

Job Duties

Start Date (Month / Year)

(Enter a four digit year)

End Date (Month / Year)

(Enter a four digit year)

Start Wage

Hourly rate or annual salary

End Wage

Hourly rate or annual salary

May we contact this employer for a reference check?

Yes

No

Statements

I certify that the statements I have made are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause for rejection or dismissal from employment. I authorize obtaining information from any person(s), employers, educational institutions, licensing authorities, and/or law enforcement agencies concerning my background, work habits, skill or conduct on the job, with the exception of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages for issuing such information.

When I am employed I agree that if at any time I make claims for personal injuries, I will submit myself, upon written request, to examination by a physician or physicians of employer's selection, at employer's expense, as often as may be requested.

I also agree that if I am employed, now or at any time in the future, my employment may be terminated at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date of my termination. I understand the term of my employment shall be limited to the duration of any assignment that I accept.

I am aware that Public Law 91-508, known as the Fair Credit Reporting Act, requires the employer to inform me that a routine inquiry may be made that will provide applicable information concerning my character, my general reputation, my personal characteristics and my credit history. Upon written request, I will provide additional information as to the nature and scope of the inquiry or any report which is produced.

I understand that I am applying for temporary or contract assignments. The completion of the this application process shall constitute a conditional offer of employment subject to my availability and the availability of customer assignments calling for the skill and qualifications that I possess, and I agree to consider acceptance of such assignments.

Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit Application button.

Initials: *

Integrated Human Capital is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.